Provider Demographics
NPI:1447214887
Name:MCGOWAN, MICHAEL JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JAMES
Last Name:MCGOWAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:12017 DRUMORE WAY
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-7054
Mailing Address - Country:US
Mailing Address - Phone:804-364-8160
Mailing Address - Fax:804-364-8162
Practice Address - Street 1:1201 BROAD ROCK BLVD
Practice Address - Street 2:HUNTER HOLMES MCGUIRE VA MEDICAL CENTER
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23249
Practice Address - Country:US
Practice Address - Phone:804-675-5000
Practice Address - Fax:804-675-5952
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA04010053061223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics